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Scientific Oral Presentation

Head and Neck Surgery

Histopathologic Outcomes and Malignancy Risk by SUMP Subcategory: A Systematic Review and Meta-analysis

Saturday, October 17, 2026
10:06 AM - 10:12 AM PT
Location: West Exhibit Hall A, Learning Zone 3

    Presenting Author(s)

  • Zachary N. Goldberg, MD

    Resident Physician
    Boston University Medical Center
    Boston, Massachusetts, United States

    • Co-Author(s)

  • AP

    Anjali Pillai, MD

    Resident Physician
    Boston University Medical Center, United States

  • AS

    Asritha S. Sure, BA

    Medical Student
    Chobanian and Avedisian School of Medicine
    Boston, Massachusetts, United States

  • SN

    Sarah C. Nyirjesy, MD

    Assistant Professor
    Department of Otolaryngology, Head and Neck Surgery, Boston University Medical Center, United States

  • MC

    Michael B. Cohen, MD

    Assistant Professor
    VA Medical Center - Boston
    Boston, MA, United States

    • Senior Author(s)

  • CR

    Charles A. Riley, MD

    Surgeon-Otolaryngology
    VA - Boston Healthcare System
    Arlington, VA, United States

Disclosure(s):
Michael B. Cohen, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Histopathologic outcomes of salivary neoplasms of uncertain malignant potential (SUMP) and their variance among Milan System subcategories remain incompletely defined. We aimed to quantify the pooled risk of malignancy (ROM) and define the distribution of benign and malignant final histopathological diagnoses across established SUMP subcategories.

Methods: A systematic review of three databases with adherence to PRISMA guidelines identified publications reporting preoperative fine needle aspiration (FNA) of parotid and/or submandibular masses demonstrating subcategories of SUMP, as well as histopathology after tumor extirpation. Ten studies were included. Random-effects meta-analysis quantified pooled ROM by subcategory, prevalence of histopathologic diagnoses, and inter-study heterogeneity (I²).

Results: Among 1,494 SUMP diagnoses after FNA, 830 had final surgical histopathology available, of which 281 were malignant. Pooled ROM was 33.8% (95% CI: 30.6-37.0%, p< 0.0001) with benign-to-malignant likelihood ratio (LR) of 1.95 and I²=65.7%. The most common benign diagnoses were pleomorphic adenoma (n=238, 43.4%) and Warthin tumor (n=74, 13.5%). The most common malignancies included mucoepidermoid carcinoma (n=59, 21.0%), adenoid cystic carcinoma (n=48, 17.1%), and acinic cell carcinoma (n=39, 13.9%). ROM varied significantly by SUMP subcategory: clear cell demonstrated highest malignancy risk (85.7%, LR 0.17, p=0.0129), followed by oncocytic (42.7%, LR 1.24, p=0.024) and basaloid (28.5%, LR 2.51, p< 0.001).

Conclusions: This analysis of SUMP histopathologic outcomes by subcategory demonstrated an overall ROM of 34%, with significant subcategory-dependent variation. Clear cell and oncocytic SUMP specimens may warrant heightened clinical suspicion and more aggressive surgical management given substantially elevated malignancy risk compared to basaloid lesions. These data provide evidence-based risk stratification that may help guide clinical decision-making for salivary gland neoplasms with indeterminate FNA cytology.